“What was your most unusual program design and why did the client need such special accommodation?”

My clients typically fall into one of three categories: top-level athletes of all ages; postrehab clients for shoulders, knees and backs; and, of course, the typical “I just want to tone” clients with whom we are all familiar.

I rarely get to utilize my experience in hospital-based physical therapy or my certifications as a clinical exercise specialist and medical exercise specialist. Although the following program may be typical for trainers who work with special populations, it is unusual for me.

I overheard a club member with multiple sclerosis (MS) mention that she would love to work with a personal trainer, but she was convinced that no trainer would have the skills to help her. Since my wife also has MS, I was familiar with the disease and was able to convince the member to work with me for a few sessions. She has had well over 100 sessions since.

In creating her program, I studied proprioceptive neuromuscular facilitation and learned the patterns that would be appropriate. I worked with our aquatics staff so that I could best reinforce and add to what she was already doing in group classes in the pool. I also picked up what I could from Pilates, Feldenkrais, yoga and t’ai chi instructors and books.

I usually prefer to use dumbbells and cables for weight training. Since there is a risk of her losing her grip, however, our program includes more manual and tubing exercises than I typically use. Many of my clients don’t do any seated exercises. Because this client uses a walker or wheelchair, I designed virtually all of her exercises to be done seated or on a plinth (a massage table that is not being used for massage). Her program also varies from that of my other clients because we spend a much larger proportion of our time increasing her flexibility.

Her program reminds me that regardless of how strongly I believe in any particular philosophy of exercise (such as ground-based “functional” training, for example), there will always be exceptions. Your favorite modality or protocol may not be best for absolutely everyone at all times. You have to keep your mind open to make sure you are doing what’s best for your client. That keeps the personal in personal training.

Stephen Holt

Education Director, Maryland Athletic Club & Wellness Center

Timonium, Maryland

I used to train a lady who weighs several hundred pounds and is unable to leave her house due to her size. She originally trained with me at my home studio. She could only walk for two minutes before the pain in her knees and feet would be too severe to continue. In the past year, her size increased to the point that she could no longer come to me. So, I had to design a home program to enable her to become more active while sitting and lying in bed. She finds it more and more difficult to stand due to her increasing size.

I developed a chair fitness program that she could perform to a video or to her favorite tunes. This program involved various upper-body movements with some stationary marching and leg variations. I also had her pedal her bike while supine on her bed. I moved the bike next to the bed and elevated it to enable her to do this valuable biking action. For strength training, we focused on isometric transversus contractions and modified planks for core work. We also did some tubing exercises for her upper and lower body. I tailored all exercises so she could perform them in a chair or on her bed.

Her challenges also involved other areas of healthy living. I focused on keeping her positive and thinking activity, activity, activity. I am presently not training this client due to her financial constraints, but hope to work out something in the near future to train her again.

Andrea Mounce-Halasz

Personal Trainer/Exercise Therapist, Activate Personal Training Services

Chester, Nova Scotia

A young man who trained with one of our trainers (Kim Morris) required some creative modifications. He was our most unusual, and most inspiring, client. He was a rockclimber and avid bushwalker who was training intensely for his next major goal—to climb Mount Kilimanjaro, Africa’s tallest peak.

While this goal is challenging for anyone, it was even more so for our client because he had lost both his legs well above the knee due to a freak bushwalking accident in April 1997. He had been walking on Hinchinbrook Island off the northeast coast of Australia when a rock the size of a car rolled on him, fracturing his pelvis and crushing both his legs. For two days he remained trapped under the rock while his
walking partner hiked out to get help. To give you an idea of the sort of grit and determination this man has, he climbed Tasmania’s Cradle Mountain using a modified wheelchair—and the seat of his pants—only 10 months after his accident!

He came to Kim wanting to increase upper-body strength for his epic climb. He already had good strength from both his general lifestyle and his rock climbing. (He still works as a rock climbing instructor as well.) He also had excellent core stability, which enabled him to perform traditional strength training exercises, such as the bench press, with no modifications.

Kim ensured that whenever possible the equipment was situated to allow him maximum independence. For example, he performed chin-ups and dips on specially lowered bars. To increase his strength via body weight exercises, he wore a weighted vest that could be adjusted to carry between two and 22 kilograms (about 4.4 to 49 pounds) of extra weight. To perform dynamic ab work such as medicine ball throws, Kim placed a mat over his upper legs and a bench with a low crossbar over the mat so that he was securely held in place. For cardiovascular fitness the client used a specially designed bike that he powered with his arms. Recently he competed in and completed a 217-kilometer (about 134.5-mile) bike race.

This client trained at quiet times in a private personal training studio, so he and his trainer felt very comfortable experimenting with different training techniques without attracting the attention of interested bystanders.

Nikki and Andrew Ellis

Directors, City Personal Training

Melbourne, Australia

About five years ago I trained a 40-year-old man who had suffered
a spinal cord injury when he was 16. Since his accident, he had been very athletic.
He had participated in wheelchair basketball, volleyball, track and field, and marathons. He had been weightlifting for a while and could easily discuss
his limitations.

His core stability was extremely poor at first so we had to use a back support whenever he was lifting, pushing or pulling. As he started to get stronger,
I positioned the bench so that his low and mid back were supported, making him use the muscles in his upper back. As he progressed, I positioned the bench lower and lower until eventually, he did not require the back support.

It was interesting to watch him while he exercised without a back support. It really taught me about co-contraction at the spinal level. If he contracted too forcefully through the abdominals, his body fell forward. If he contracted too forcefully in his back extensors, his body fell backward. His body moved forward and backward until he found the equilibrium or the true point of co-contraction. It was exciting to watch how his muscles worked when he couldn’t use his leg muscles to help maintain his posture.

As he improved, we progressed him to exercising on a stability ball. Imagine trying to sit on a ball without the use of your legs. It was quite a challenge, but he was determined. His muscles adapted very quickly to the point that he could lift, push and pull substantial amounts of weight with no trouble.

I had to be very creative when designing other stabilization exercises for him since he couldn’t perform traditional supine leg lowers/lifts. I created exercises in which I stood behind him and pressed on his back, pushing him forward. He had to resist my force and maintain upright posture, which conditioned his back extensors. Then, in contrast, I stood in front of him and pressed lightly on his front shoulders. Again, he would have to resist my pressure and maintain his posture, which conditioned his abdominals.
I also created exercises using a pole;
I held on to one end and he held on
to the other. The object of the “game” was for him to remain completely still while I pulled on the pole from all different angles—standing to the side of him, standing above him on a chair or positioned lower than him.

I found that training an individual who has a condition that I didn’t have
a lot of experience with helped me to think outside of the box and use my creative juices.

Sherri McMillan, MSc

Vice President, NorthWest Personal Training and Fitness Education

1998 IDEA Personal Trainer of
the Year

Vancouver, Washington

The most unusual program I have designed is for a single-leg amputee client. She also had developed some back problems from being pregnant, and the knee joint of her prosthetic leg did not match up with the knee joint of her other leg. Therefore, I had to be creative in designing her program so I wouldn’t throw off her body any more than it was.

I designed a program in which we could do as many exercises as possible unilaterally. Although nobody’s body will be 100-percent balanced, I tried to work her nondominant side as much as possible. I incorporated a lot of exercises for her abs, hip and back with the use of the Bosu (a “ball” that is flat on one side and rounded on the other), fit balls and exertubes. A typical workout consists of a warm-up on an elliptical trainer (balance needed in weight shift), floor work (pelvic and spine stabilization exercises), functional exercises (standing unilateral exercises, rowing/pressing) and a thorough flexibility program. Her back pain has disappeared for the most part and her strength and balance have increased tremendously.

Brad Ruger

ACSM Health Fitness Instructor,
180 Degree’s

Atlanta

AAAIDEA PERSONAL Trainer FEbruary 2002 tricks of the trade IDEA PERSONAL Trainer FEbruary 2002AIDEA PERSONAL Trainer FEbruary 2002 tricks of the tradeAIf you have a question, send it to
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